Research Consent and Authorization Helix Research Network( HRN)
OR REVIEW ONLY
IRB APPROVED May 19, 2025
Documentation of Consent: My signature below indicates that I agree to the following:
● I have had all of my questions answered about the study
● I have had time to review the study and read the consent form
● I am willing to participate in the study
● I have been told my participation is voluntary, will not affect my care, and that I can withdraw at any time
● My contact information may be used to tell me about studies that are not part of the Helix Research Network
● Researchers will do future studies using the information and samples collected as part of this study. Their research may be on nearly any topic.
Documentation of Eligibility: My signature below confirms that the following are true:
● I am 18 years and older
● I am willing and able to comply with all aspects of the protocol
● I have not had an allogenic(“ donor”) bone marrow transplant
● I have not had an allogenic(“ donor”) stem cell transplant
____________________________ Printed Name of Participant
___________________________ Signature of Participant
____________________________ Date
Version 7, 02 / 17 / 2025 Page 15 of 18 Renown V2, 05 / 07 / 2025